Uniform Residential Loan Application - Fannie Mae

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´╗┐Uniform Residential Loan Application

___________________________________________________________________________________________________________________________________________________________________ This application is designed to be completed by the applicant(s) with the Lender's assistance. Applicants should complete this form as "Borrower" or "Co-Borrower," as applicable. Co-Borrower information must also be provided (and the appropriate box checked) when the income or assets of a person other than the Borrower (including the Borrower's spouse) will be used as a basis for loan qualification or the income or assets of the Borrower's spouse or other person who has community property rights pursuant to state law will not be used as a basis for loan qualification, but his or her liabilities must be considered because the spouse or other person has community property rights pursuant to applicable law and Borrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit (sign below):

_________________________________________ Borrower

_________________________________________ Co-Borrower

I. TYPE OF MORTGAGE AND TERMS OF LOAN

Mortgage

VA

Applied for:

FHA

Conventional USDA/Rural Housing Service

Other (explain):

Agency Case Number

Amount $

Interest Rate

No. of Months %

Amortization Type:

Fixed Rate GPM

Other (explain): ARM (type):

II. PROPERTY INFORMATION AND PURPOSE OF LOAN

Subject Property Address (street, city, state & ZIP)

Lender Case Number

No. of Units

Legal Description of Subject Property (attach description if necessary)

Year Built

Purpose of Loan

Purchase Refinance

Construction

Other (explain):

Construction-Permanent

Property will be: Primary Residence

Secondary Residence

Investment

Complete this line if construction or construction-permanent loan.

Year Lot Acquired

Original Cost

Amount Existing Liens

$

$

Complete this line if this is a refinance loan.

Year Acquired

Original Cost

Amount Existing Liens

(a) Present Value of Lot $ Purpose of Refinance

(b) Cost of Improvements $ Describe Improvements

Total (a + b) $ 0.00

made

to be made

$

$

Title will be held in what Name(s)

Source of Down Payment, Settlement Charges, and/or Subordinate Financing (explain)

Cost: $ Manner in which Title will be held

Estate will be held in:

Fee Simple Leasehold (show

expiration date)

Borrower Borrower's Name (include Jr. or Sr. if applicable)

Social Security Number

Home Phone (incl. area code)

III. BORROWER INFORMATION Co-Borrower's Name (include Jr. or Sr. if applicable)

DOB (mm/dd/yyyy) Yrs. School Social Security Number

Home Phone (incl. area code)

Co-Borrower DOB (mm/dd/yyyy) Yrs. School

Married Separated

Unmarried (include single, divorced, widowed)

Present Address (street, city, state, ZIP)

Dependents (not listed by Co-Borrower)

no.

ages

Own

Rent ____No. Yrs.

Married Separated

Unmarried (include single, divorced, widowed)

Present Address (street, city, state, ZIP)

Dependents (not listed by Borrower)

no.

ages

Own

Rent ____No. Yrs.

Mailing Address, if different from Present Address

Mailing Address, if different from Present Address

If residing at present address for less than two years, complete the following:

Former Address (street, city, state, ZIP)

Own

Rent ____No. Yrs.

Former Address (street, city, state, ZIP)

Borrower Name & Address of Employer

IV. EMPLOYMENT INFORMATION

Self Employed Yrs. on this job

Name & Address of Employer

Yrs. employed in this line of work/profession

Own

Rent ____No. Yrs.

Co-Borrower Self Employed Yrs. on this job

Yrs. employed in this line of work/profession

Position/Title/Type of Business

Business Phone (incl. area code)

Position/Title/Type of Business

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Business Phone (incl. area code)

Uniform Residential Loan Application Freddie Mac Form 65 7/05 (rev.6/09)

Page 1 of 5

Fannie Mae Form 1003 7/05 (rev.6/09)

Borrower Name & Address of Employer

IV. EMPLOYMENT INFORMATION (cont'd)

Self Employed Dates (from ? to)

Name & Address of Employer

Co-Borrower Self Employed Dates (from ? to)

Position/Title/Type of Business

Monthly Income

$ Business Phone (incl. area code)

Position/Title/Type of Business

Monthly Income

$ Business Phone (incl. area code)

Name & Address of Employer

Self Employed Dates (from ? to)

Name & Address of Employer

Self Employed Dates (from ? to)

Monthly Income

Monthly Income

Position/Title/Type of Business

$ Business Phone (incl. area code)

Position/Title/Type of Business

$ Business Phone (incl. area code)

Gross Monthly Income Base Empl. Income* Overtime Bonuses

Commissions Dividends/Interest Net Rental Income

V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION

Borrower

Co-Borrower

Total

Combined Monthly Housing Expense

$

$

$ 0.00

Rent

$

0.00

First Mortgage (P&I)

0.00

Other Financing (P&I)

0.00

Hazard Insurance

0.00

Real Estate Taxes

0.00

Mortgage Insurance

Present

Proposed $

Other (before completing,

see the notice in "describe other income," below)

Total

$ 0.00

$ 0.00

0.00 $ 0.00

Homeowner Assn. Dues Other: Total

$ 0.00

$ 0.00

* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

Describe Other Income B/C

Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.

Monthly Amount $

VI. ASSETS AND LIABILITIES

This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise, separate Statements and Schedules are required. If the Co-Borrower section was completed about a non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.

Completed Jointly Not Jointly

ASSETS

Description Cash deposit toward purchase held by:

Cash or Market Value

$

Liabilities and Pledged Assets. List the creditor's name, address, and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary. Indicate by (*) those liabilities, which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.

List checking and savings accounts below Name and address of Bank, S&L, or Credit Union

LIABILITIES Name and address of Company

Monthly Payment & Months Left to Pay

$ Payment/Months

Unpaid Balance $

Acct. no.

$

Name and address of Bank, S&L, or Credit Union

Acct. no.

$

Name and address of Bank, S&L, or Credit Union

Acct. no.

$

Uniform Residential Loan Application Freddie Mac Form 65 7/05 (rev. 6/09)

Acct. no. Name and address of Company

Acct. no. Name and address of Company

Acct. no.

Page 2 of 5

$ Payment/Months

$

$ Payment/Months

$

Fannie Mae Form 1003 7/05 (rev.6/09)

Name and address of Bank, S&L, or Credit Union

Acct. no.

$

Stocks & Bonds (Company name/

$

number & description)

Life insurance net cash value

$

Face amount: $

Subtotal Liquid Assets

Real estate owned (enter market value from schedule of real estate owned) Vested interest in retirement fund

Net worth of business(es) owned (attach financial statement) Automobiles owned (make and year)

$ 0.00 $ $ $

$

Other Assets (itemize)

$

VI. ASSETS AND LIABILITIES (cont'd)

Name and address of Company

$ Payment/Months

$

Acct. no. Name and address of Company

$ Payment/Months

$

Acct. no. Name and address of Company

$ Payment/Months

$

Acct. no.

Alimony/Child Support/Separate Maintenance Payments Owed to:

$

Job-Related Expense (child care, union dues, etc.) $

Total Monthly Payments

Total Assets a. $ 0.00

Net Worth

(a minus b)

Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)

$ 0.00

Property Address (enter S if sold, PS if pending sale or R if rental being held for income)

Type of Property

Present Market Value

$

Amount of Mortgages

& Liens

$

$ Total Liabilities b. $ 0.00

Gross Rental Income

Mortgage Payments

$

$

Insurance, Maintenance, Taxes & Misc.

$

Net Rental Income

$

0.00

0.00

0.00

0.00

0.00

Totals

$

$

$

$

$

$

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):

Alternate Name

Creditor Name

Account Number

VII. DETAILS OF TRANSACTION

a. Purchase price

$

b. Alterations, improvements, repairs c. Land (if acquired separately) d. Refinance (incl. debts to be paid off) e. Estimated prepaid items f. Estimated closing costs g. PMI, MIP, Funding Fee h. Discount (if Borrower will pay) i. Total costs (add items a through h)

Uniform Residential Loan Application Freddie Mac Form 65 7/05 (rev.6/09)

0.00

VIII. DECLARATIONS If you answer "Yes" to any questions a through i, please use continuation sheet for explanation.

a. Are there any outstanding judgments against you?

b. Have you been declared bankrupt within the past 7 years?

c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?

d. Are you a party to a lawsuit?

e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?

(This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes," provide details, including date, name, and address of Lender, FHA or VA case number, if any, and reasons for the action.)

Borrower Yes No

Co-Borrower Yes No

Page 3 of 5

Fannie Mae Form 1003 7/05 (rev.6/09)

VII. DETAILS OF TRANSACTION

j.

Subordinate financing

k.

Borrower's closing costs paid by

Seller

l.

Other Credits (explain)

VIII. DECLARATIONS

If you answer "Yes" to any question a through i, please use continuation sheet for explanation.

Borrower

Yes

No

f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?

g. Are you obligated to pay alimony, child support, or separate maintenance?

h. Is any part of the down payment borrowed?

i. Are you a co-maker or endorser on a note?

Co-Borrower

Yes

No

m. Loan amount (exclude PMI, MIP, Funding Fee financed)

n.

PMI, MIP, Funding Fee financed

------------------------------------------------------j. Are you a U.S. citizen? k. Are you a permanent resident alien?

o.

Loan amount

(add m & n)

0.00

l. Do you intend to occupy the property as your primary residence?

If Yes," complete question m below.

p.

Cash from/to Borrower

(subtract j, k, l & o from i)

m. Have you had an ownership interest in a property in the last three years?

(1) What type of property did you own--principal residence (PR), second home (SH), or investment property (IP)?

(2) How did you hold title to the home-- by yourself (S), jointly with your spouse (SP), or jointly with another person (O)? IX. ACKNOWLEDGEMENT AND AGREEMENT

Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents, brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors or assigns may, in addition to any other ri ghts and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be tra nsferred with such notice as m ay be require d by law; (10) neither Lender nor i ts agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an "electronic record" containing my " electronic signature," as those terms are d efined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my s ignature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.

Borrower's Signature

X

Date

Co-Borrower's Signature

Date

X

X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and ho me mortgage disclosure laws . You are no t requ ired to furnish this in formation, bu t are en couraged to do so . Th e law p rovides t hat a le nder m ay not discriminate ei ther o n t he bas is of t his information, or on whether you ch oose to fu rnish it . If y ou fu rnish th e information, p lease provide bot h ethnicity and race. Fo r race, you may check m ore than one designation. If you do not furnish ethnicity, race, o r sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)

BORROWER

I do not wish to furnish this information

Ethnicity:

Hispanic or Latino

Not Hispanic or Latino

CO-BORROWER

I do not wish to furnish this information

Ethnicity:

Hispanic or Latino Not Hispanic or Latino

Race:

American Indian or Alaska Native Native Hawaiian or Other Pacific Islander

Asian White

Black or African American

Race:

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Asian White

Black or African American

Sex:

Female

Male

To be Completed by Loan Originator:

This information was provided:

In a face-to-face interview

In a telephone interview

By the applicant and submitted by fax or mail

By the applicant and submitted via e-mail or the Internet

Sex:

Female

Male

Loan Originator's Signature

X

Loan Originator's Name (print or type)

Loan Originator Identifier

Date Loan Originator's Phone Number (including area code)

Loan Origination Company's Name

Loan Origination Company Identifier

Loan Origination Company's Address

Uniform Residential Loan Application Freddie Mac Form 65 7/05 (rev.6/09)

Page 4 of 5

Fannie Mae Form 1003 7/05 (rev.6/09)

Use this continuation sheet if you need more space to complete the Residential Loan Application. Mark B f or Borrower or C for Co-Borrower.

CONTINUATION SHEET/RESIDENTIAL LOAN APPLICATION

Borrower:

Agency Case Number:

Co-Borrower:

Lender Case Number:

______________________________________________________________________________________________________________________________________________

I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions

of Title 18, United States Code, Section 1001, et seq.

Borrower's Signature

Date

Co-Borrower's Signature

Date

X

X

Uniform Residential Loan Application Freddie Mac Form 65 7/05 (rev.6/09)

Page 5 of 5

Fannie Mae Form 1003 7/05 (rev.6/09)

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